No advantage of quadruple or triple-class antiretroviral therapy as initial treatment in patients with very high viraemia.

MedLine Citation:

PMID:
22909444
Owner:
NLM
Status:
Publisher

Abstract/OtherAbstract:

Background We assessed whether quadruple or triple-class therapy for the initial treatment of HIV-1 infection provides a virological benefit over standard triple therapy in patients with a very high plasma viraemia.Design National observational HIV cohort in the Netherlands.Methods Inclusion criteria were age ≥18 years, treatment-naïve, plasma viral load (pVL) ≥500.000 copies/ml and initiation of quadruple or triple therapy between 2001-2011. Time to viral suppression, defined as pVL <50 c/ml, was compared between the two groups using Kaplan-Meier plots and multivariate Cox regression analysis.Results 675 patients were included: 125 (19%) initiated quadruple and 550 (81%) triple therapy. Median pVL was 5.9 (IQR 5.8-6.1) log(10) c/ml in both groups (P=0.49). 22 (18%) patients on quadruple and 63 (12%) on triple therapy interrupted the treatment regimen because of drug-related toxicity (P=0.06). Median time to viral suppression was 5.8 (IQR 4.6-7.9) and 6.0 (4.0-9.4) months in the patients on quadruple and triple therapy (log rank, P=0.42). In the adjusted Cox analysis, quadruple therapy was not associated with time to viral suppression (HR 1.07 (95% CI 0.86-1.33), P=0.53). Similar results were seen when comparing triple- versus dual-class therapy (n=72 vs. n=601, respectively).Conclusions Initial quadruple or triple-class therapy was equally effective as standard triple therapy in the suppression of HIV-1 in treatment-naïve patients with very high viraemia and did not result in a faster pVL decline, but did expose patients to additional toxicity.